From parents: doubt and distrust

For the new child-based, flu-control strategy to work, families of children ages 5 to 18 must embrace the recommendation. And that won't happen easily.

Cost is not likely to be an obstacle -- flu shots cost only about $20 to $30 at the lowest-cost centers, such as public health clinics and drugstores, and many children are eligible for no-cost or low-cost vaccination through the government's Vaccines for Children Program. Rather, the potential show-stoppers are inconvenience and public distrust of vaccinations.

Sarah Outlaw, the mother of children ages 7, 5 and 2, says her children will not be getting flu shots. The Saugus resident is not convinced the vaccine is safe or effective. Neither she nor her children have ever had a flu shot or developed the flu, but her husband received a flu shot for several years during the time he served in the military and often got the flu weeks later.

"I think there is an overuse of flu vaccine," says Outlaw, who runs a business from her home in Saugus. "So many people have told me they have gotten the flu after getting the vaccine.

"I research them every year. Last year they had the wrong strains. It was ineffective and a waste."

Outlaw says she believes people are scared into getting the vaccine.

"Even with the new mandates, I'm not going to do it," she says. "You have to make the decision for yourself. We have college degrees. We know what we're doing. Parents know what is best for their children."

Under the current Centers for Disease Control and Prevention guidelines, children need more than one dozen immunizations to protect against a range of diseases, and some parents grow weary of the overall vaccination demands. Others express concern about safety of vaccines that contain the mercury-containing compound thimerosal, a preservative that some people believe may be toxic to infants and children. (The Food and Drug Administration says there is no evidence to support a link between thimerosal and complications from vaccines, such as autism.)

But parents have choices of flu vaccine, says Dr. Jeanne Santoli of the CDC. There are two types of vaccines: an injection that uses killed virus and an intranasal spray that uses live but weakened virus. The latter is sold under the brand name FluMist and licensed for use among non-pregnant people ages 2 through 49.

Some vaccines are thimerosal-free or carry only trace amounts of thimerosal: one product licensed for use for children ages 6 to 35 months (Sanofi's Fluzone single-dose pre-filled 0.25 mL syringe or vial) and three products for children ages 2 to 5 (Sanofi's Fluzone single-dose; MedImmune's FluMist and Novartis' Fluvirin single-dose pre-filled 0.5 mL syringe, which is for people ages 4 and older.

Two vaccines that are commonly used in kids contain thimerosal (Sanofi's Fluzone in the multi-dose vial and Novartis' Fluvirin in the multi-dose vial). Most of the vaccines licensed for use only in adults contain thimerosal.

The maker of FluMist tripled its supply of vaccine this, on the heels of a study published last year in the New England Journal of Medicine that showed the live attenuated virus vaccine is more effective in preventing the flu compared with inactivated vaccine.

Other flu manufacturers have increased their production this season, and public health officials aren't worried about the kinds of vaccine shortages that have occurred in recent years. The state Department of Health Services has bolstered its supply of flu vaccine by 25% this year to accommodate the age 5-to-18 group. And the state's 4,000 or so providers in the Vaccines for Children Program have been forewarned about the new recommendation, says John Talarico of the California Department of Health Services.

"That being said, we know this is a hard task," he concedes of the goal of vaccinating almost every child in the U.S.

And simply convincing parents of the need for immunization is only the first step in the child-vaccination push. Then there's the matter of getting the immunization. It's inconvenient for parents to take time off work to take a healthy child to the doctor for a flu shot within the three-month flu-shot season. And, while younger children usually have a pediatrician, many teens don't have a regular health-care provider.